Prior to its identification as a neurologic condition separate and distinct from insanity, patients that would later be diagnosed with Alzheimer's disease often languished in asylums. The picture you see to the left is the actual City Asylum for the Insane and Epileptic, in Frankfurt am Main, Germany. This is where the diagnoses of dementia and mental illness became identified as Alzheimer's disease.

Alzheimer-Munich: Cerebral Cortex On an Unusual Illness of the Cerebral Cortex

During a presentation of his 1907 paper, "Über eine eigenartige Erkankung der Hirnrinde" Dr. Alzheimer relates a case he had observed in the insane asylum of Frankfurt am Main. The central nervous system of his patient Auguste Deter was provided to him for analyses and the resulting paper was presented,

Clinical observation alone made the case appear so unusual that it could not be classified as one of the recognized illnesses; it showed anatomical characteristics which set it apart from all recognized cases.

The first symptom the 51-year-old woman exhibited was a profound jealousy of her husband and accusations of infidelity. Soon she developed a rapid loss of memory. She was disoriented in her home, carried things from one place to another and hid them, sometimes she thought some- body was trying to kill her and started to cry loudly.

Dr. Alois Alzheimer, a German neurologist, examined Auguste Deter in November of 1901. She was 51 years of age and presented with symptoms not unlike the prevailing markers of dementia but due to her age the diagnosis was “presenile dementia”.

Her husband finally sought medical attention due to psychotic behavior and abnormal disorders of thinking and communicating. You can see in the notes that follow that she is trying to make sense of her surroundings and be as cooperative as possible but the confusion and difficulties with recall and self-identification are evident.

What is your name?

She sits on the bed with a helpless expression. What is your name? Auguste. Last name? Auguste. What is your husband’s name? Auguste, I think. Your husband? Ah, my husband. She looks as if she didn’t understand the question. Are you married? To Auguste. Mrs D? Yes, yes, Auguste D. How long have you been here? She seems to be trying to remember. Three weeks. What is this? I show her a pencil. A pen. A purse and key, diary, cigar are identified correctly. At lunch she eats cauliflower and pork. Asked what she is eating she answers spinach. When she was chewing meat and asked what she was doing, she answered potatoes and then horseradish. When objects are shown to her, she does not remember after a short time which objects have been shown. In between she always speaks about twins. When she is asked to write, she holds the book in such a way that one has the impression that she has a loss in the right visual field. Asked to write Auguste D, she tries to write Mrs and forgets the rest. It is necessary to repeat every word. Amnestic writing disorder. In the evening her spontaneous speech is full of paraphrasic derailments and perseverations.

Extracts from Nov 29, 1901

. . .What year is it? Eighteen hundred. Are you ill? Second month. What are the names of the patients? She answers quickly and correctly. What month is it now? The 11th. What is the name of the 11th month? The last one, if not the last one. Which one? I don’t know. What colour is snow? White. Soot? Black. The sky? Blue. Meadows? Green. How many fingers do you have? 5. Eyes? 2. Legs? 2.

. . . If you buy 6 eggs, at 7 dimes each, how much is it? Differently. On what street do you live? I can tell you, I must wait a bit. What did I ask you? Well, this is Frankfurt am Main. On what street do you live? Waldemarstreet, not, no. . . . When did you marry? I don’t know at present. The woman lives on the same floor. Which woman? The woman where we are living. The patient calls Mrs G, Mrs G, here a step deeper, she lives. . . .I show her a key, a pencil and a book and she names them correctly. What did I show you? I don’t know, I don’t know. It’s difficult isn’t it? So anxious, so anxious. I show her 3 fingers; how many fingers? 3. Are you still anxious Yes. How many fingers did I show you? Well this is Frankfurt am Main.

In spite of these remarkable findings the case presentation received lukewarm attention and little to no discussion following the conference for quite some time--in spite of the symptoms characterized in a woman significantly younger than a typical patient with dementia. Questions to explore include the questionable naming of the disease after Alois Alzheimer and the disappearance and reappearance of Auguste Deter's brain many years later...

Comments are closed.

Bonny

A medical writer and insight analyst focuses the lens on the evolution of Alzheimer's Disease as a diagnosis into a billion dollar healthcare juggernaut